Healthcare Provider Details

I. General information

NPI: 1538166152
Provider Name (Legal Business Name): PAUL ZIDEL I M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2005
Last Update Date: 02/27/2015
Certification Date:
Deactivation Date: 03/17/2006
Reactivation Date: 04/03/2006

III. Provider practice location address

2601 E ROOSEVELT ST DEPT OF SURGERY
PHOENIX AZ
85008-4973
US

IV. Provider business mailing address

2929 E THOMAS RD
PHOENIX AZ
85016-8034
US

V. Phone/Fax

Practice location:
  • Phone: 602-344-5371
  • Fax: 602-344-5048
Mailing address:
  • Phone: 602-470-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberME61176
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: